As a family physician in a small town, I treat a lot of health conditions.
I treat high blood pressure and asthma. I treat the flu. I make sure small children get their vaccinations.
However, unlike most family physicians, I also treat patients with opiate addiction, or, as the medical world calls it, opiate use disorder.
Surprisingly to many people, they are the most satisfying patients I treat.
Even more surprisingly, I especially enjoy treating pregnant women.
In 25 years of practice, no one has ever thanked me for bringing their blood pressure under control. However, at least once a month, one of my patients with opiate use disorder thanks me for saving their life.
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Recently, I saw a little boy, about 4, for a well-child visit. He is healthy, rambunctious, and happy — clearly well-loved and well taken care of.
His mother was using heroin when she became pregnant with him. She was 19 when I met her, embarrassed and afraid, but determined to do well for her baby. Her own mother, also a user, did her best to derail treatment — even slipping something into her drink one time.
The child’s father and his family stood by the young woman throughout the pregnancy, and she succeeded. I provided her with prenatal care, helping to ensure the health of her baby. I also provided her with medication treatment for her opiate use disorder.
Today, that young woman remains heroin-free. She is still with her boyfriend, and all three of them are doing well.
Whenever I see that little boy, I feel happy.
This young woman’s story is not unusual. There are so many people out there who want treatment. If the commitment is there, I can often help them to get their lives back on track.
It wasn’t always like that.
I have been practicing at El Centro Family Health in Española , N.M., for 22 years. Long before heroin hit the rest of the country, it was a huge issue in my community. Although fewer than 11,000 people live in Española, we often have the highest per-capita overdose death rate in the country. Unfortunately, the problem has gotten worse since the advent of the painkiller epidemic.
Back when I started, I did what I could for patients with opiate use disorders. I referred them to Narcotics Anonymous and the methadone clinic. I treated their abscesses. I did my best to be supportive and make sure they got treatment for their other medical problems. However, I felt like there was little I could do myself for their opiate use disorders.
In 2003, I began treating patients with hepatitis C — also a huge and largely untreated problem in my community — with the help of Project ECHO at the University of New Mexico.
Project ECHO provides remote training for primary care providers who want to learn how to treat patients with complex conditions. When Project ECHO expanded to treat opiate use disorder with buprenorphine, I signed up for the first training. In 2005, I became the first physician in my community to prescribe buprenorphine for opiate use disorder.
About three months after I started prescribing, a former drug dealer who wanted to get away from the lifestyle came in for treatment. He was so excited to find a treatment that worked for him that he referred everyone he knew. I like to think of him as my first community health worker. I asked him once how he was able to get so many people to come in to the clinic.
His response: “There’s no such thing as a happy heroin addict.”
I got a lot of experience very quickly. In addition, because I am a family physician who was already taking care of pregnant women, I developed expertise that few other physicians had in treating them. Many of these women now have happy, healthy toddlers.
I feel very lucky that, in addition to taking care of patients myself, I have become part of the ECHO “learning loop,” training other physicians in the use of buprenorphine and treatment of opiate use disorder in pregnancy. I am grateful to have been able to give back.
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A great deal needs to be done to address the opioid crisis. However, the piece that hits closest to home for me is the need for more primary care providers to commit to treating patients with opioid use disorder. With a significant commitment from primary care providers, we could make a huge dent in this problem.
In my community, only two other physicians are prescribing buprenorphine, and it’s not enough. Many communities have none at all.
The vast majority of primary care physicians receive almost no training during their residencies on how to treat opiate use disorder. Because of this, many of us lack both the expertise and the confidence to offer treatment. The 8-hour training certification course for buprenorphine treatment is helpful, but, for many physicians, it is not enough.
The mentorship provided by Project ECHO can make a big difference, so that physicians feel prepared to actually provide care to patients struggling with opiate use disorder.
Helping patients with opiate use disorder has been one of the most gratifying things I’ve done as a primary care physician. I encourage all primary care physicians to consider getting the training and support they need to do the same.
If you want to learn more about Project ECHO — or if you would like your doctor to learn more about Project ECHO — please email the ECHO team at ECHOreplication@salud.unm.edu.